Biomedical subjects
R A Chez
Publications and source records attributed to R A Chez.
Women's health care centers: barriers or opportunities?
A proactive plan is required to minimize societal, health provider and the individual woman's barriers to the implementation of comprehensive holistic women's health centers .
Carbohydrate metabolism after three months of using a gestodene-containing monophasic oral contraceptive.
Carbohydrate metabolism was prospectively evaluated in twenty-one normal women prior to and during their use for three months of a monophasic oral contraceptive containing the progestin gestodene plus ethinyl estradiol. The women had a three-hour oral glucose tolerance test using a 75 gram glucose load, measuring serum glucose and insulin levels. The results demonstrate no significant changes in either of the carbohydrate metabolic indices between the two tests. These data support the safety of this new progestin-containing contraceptive.
Six-month carbohydrate metabolism studies in women using oral contraceptives containing gestodene and ethinyl estradiol.
Twenty-five women had their carbohydrate metabolism prospectively evaluated during the six months that they used a gestodene and ethinyl estradiol monophasic oral contraceptive. Serum glucose and insulin levels were measured during a 75-gram three-hour oral glucose tolerance test. At the six-month test, the three-hour glucose and the fasting and three-hour insulin values were significantly elevated. The literature on carbohydrate metabolism during gestodene oral contraceptive use is also reviewed.
Women's health care: rights and responsibilities.
We recently participated in efforts to implement community-based women's health programs in regions of the world that are undergoing broad reforms as one form of government is replaced by another. In the course of these activities, we have had reason to review the rich and voluminous literature on the pivotal contributions by patients, providers, and society that result in optimal health for women. This article reflects our perspective of that literature and a framework to achieve that goal.
Effect of explicit criteria on nonstress test evaluation by obstetric nurses.
The ability to interpret five nonstress tests (NST) was evaluated with a mail survey of obstetric nurses. One group of nurses (402) used their own criteria for interpreting the test as reactive, nonreactive, or equivocal. The other group (396) used explicitly defined criteria. There was no relationship in either group between the accuracy of response to past training, number of years in nursing, or daily experience with the NST. Furthermore, the provision of diagnostic criteria did not affect either the accuracy of response or the translation of the NST into an assessment of fetal well-being. These responses of obstetric nurses were equivalent to those of obstetricians who evaluated these same tracings in a previous study. These data support a conclusion that the obstetric nurse can interpret the NST with a level of reliability commensurate with obstetricians.
Effect of labor on intelligence of the offspring.
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Effect of maternal-fetal movement on concentration of cells obtained at genetic amniocentesis.
The number of viable amniotic fluid cells in the aliquot obtained at amniocentesis is an important determinant of the success of subsequent cell culture. However, cell concentration and viability are highly variable, even in samples of equivalent gestational age. We studied the effect of prescribed maternal position change or spontaneous fetal movement on the concentration, viability, and subsequent harvest time of amniotic fluid cells removed at genetic amniocentesis. Samples from 108 patients at 15 to 22 weeks' gestation were evaluated. We did not find a relationship between this type of maternal or fetal movement and the retrieval of amniotic fluid cells.
Maternal deaths in New Jersey: 1988.
Physicians reported 56 maternal deaths in New Jersey in 1988. AIDS, adult respiratory distress syndrome, and trauma were dominant causes of maternal demise. There continues to be value in reviewing maternal deaths. The authors detail a model protocol.
Vaginal birth after cesarean section.
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Clinical aspects of three new progestogens: desogestrel, gestodene, and norgestimate.
Three new 19-nortestosterone progestogens, which are chemically related to levonorgestrel, are now clinically available in combination oral contraceptives in Europe. Desogestrel and norgestimate must be transformed to metabolites for all or part of their biologic activity; gestodene is active in its original form. Compared with present low-dose monophasic and triphasic levonorgestrel formulations, the new combinations appear to be equivalent in efficacy and type and frequency of side effects. Cycle control may be slightly improved with the gestodene preparation and somewhat poorer with the desogestrel regimen. As with the present triphasics, most changes reported in coagulation indexes for the new combinations remained within normal limits, as did changes in carbohydrate and lipid metabolism. There is no present evidence that either the norgestimate or aesogestrel formulation provides a clinical improvement over the levonorgestrel triphasic. In the gestodene combination, the progestogen's increased biologic activity allows further reduction of total steroid dose.
Metabolic aspects of the new low-dose oral contraceptives.
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Exact timing of the one-hour glucose sample as a factor in the screen for gestational diabetes.
We examined the exactness of the timing of the 1-hour glucose sample following a 50-g oral glucose challenge as a critical variable in interpretation of the test. Heparin locks were placed in 45 pregnant patients between 25 and 28 weeks' gestation, and 5 patients between 30 and 33 weeks' gestation. Venous samples were taken at intervals of 50, 60, and 70 minutes from completion of the ingestion of a 50-g oral glucose load. We found all of the nine possible patterns of blood glucose values that can derive from three sequential values. There was no consistent relationship between these 60 +/- 10 minute values. Two of the patients had a 60-minute value greater than 140 mg/dL, but a 50- or 70-minute value that was less than 140 mg/dL. Four of the patients had a 50- or 70-minute value that was greater than 140 mg/dL, but a 60-minute value that was less than 140 mg/mL. The range of results in this study reflects a continuum of values that change rapidly over time and in patterns that are not predictable. We conclude that accurate timing is important to avoid erroneous interpretation of the 1-hour glucose screen.
Woman battering.
Woman battering is a common phenomenon in our society. The number of women effected means that most obstetrician-gynecologists have patients in their practice who are victims. When the diagnosis is suspected, it is necessary to question the patient directly. Therapy involves the use of resources mostly outside of the office. Therefore, the physician assumes the role of (1) permission giving through mutual acknowledgement that the problem exists and is deserving of remedial action and (2) information giving by providing the patient sources of relief from the abuse.
Obstetrics: state of the science, 1988.
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Ketonuria in normal pregnancy.
Nine low-risk, clinically normal pregnant women tested their urine for ketone bodies at three- to four-day intervals throughout gestation. Eight of the women had acetoacetonuria present on two to 15 days each. This finding was not related to length of gestation or time of day. Ketonuria probably occurs sporadically in most normal pregnancies.
Weight gain during pregnancy.
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Reconsidering the "market model" in obstetrics. Part II.
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